 Robert Todd Carroll
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substance abuse treatment
Substance abuse treatment is a behavior modification therapy for those who use drugs or alcohol to the detriment of themselves and others. Law enforcement officials, politicians, and religious leaders often cite drug and alcohol abuse as evils so great that they threaten the survival of our society. Countless individuals worry constantly about their own and others' drinking or drug behaviors. Waiting to help all those with substance abuse "problems" are thousands of professionals in the "helping" professions. But are they really helping substance abusers? Or is substance abuse treatment (SAT) a racket designed primarily to make money or to promote some other selfish goal, with little regard for the health or well-being of patients? Or is SAT a mixture of good and evil, much like the people it avers to help? the road to Hell is paved with good intentions Criticizing those who profess to help substance abusers is unlikely to be welcomed either by those who see substance abuse as a subversive activity or by those who believe their own lives or the lives of loved ones have been or are now being destroyed by drugs or alcohol. The psychologists, psychiatrists, interventionists and aides who work in treatment facilities are unlikely to welcome criticism. Likewise for the owners and managers of such places. Nevertheless, it is unconscionable to allow an industry to go unchecked simply because they claim to have good intentions. Charles Dederich (1913-1997), who created Synanon, had good intentions. He would help drug addicts. In a little over twenty years, from 1958 to 1980, Synanon grew to an authoritarian cult with perhaps between $30 million and $50 million in assets. Instead of saving families, Synanon destroyed them. Of the 6,000 to 10,000 residents of Synanon between 1958 and 1968, only 65 people were rehabilitated, i.e., reached Synanon's stated goal of choosing to live and work outside of the Synanon community (Ofsche 1980, 110). His empire collapsed when he pleaded no contest to a charge of conspiracy to commit murder. How do the Dederichs of the world get away with it? In his case, he was doing society's dirty business of helping drug addicts. To attack a person or an organization which is helping people is to show bad form and will generally be unrewarded. Furthermore, we all want such endeavors to succeed and are more apt to seek out confirmation of their successes than to criticize their failures. Programs like Synanon are the darlings of the media--and politicians in election years--until their warts become too obvious to ignore. Unfortunately, these natural tendencies gives the unscrupulous carte blanche to abuse the rest of us. The goals of SAT may be noble, but that does not justify using any means necessary to achieve those goals. To allow treatment which denies a person his or her human as well as civil rights should not be tolerated. To treat people for questionable diseases should not be tolerated. To use therapeutic techniques with little or no substantive evidence for their effectiveness should not be tolerated. While there are many SAT programs that respect the basic humanity of their patients and do a good and decent job of helping substance abusers, there are also programs that are not being monitored carefully by anyone, thus inviting abuse. professional interventionists Interventions are commonly used on those thought to be drug or alcohol abusers by concerned relatives and friends. The element of surprise is often used in these interventions. Several people, including in some cases a professional interventionist, confront the subject who is immediately on the defensive. Not that it much matters, for any defense is taken as “being in denial.” The shock of the intervention, its humiliating aspects, the intimidation of numbers, all combine to prevent any sort of rational exploration of the situation. This is of little importance, since the intervention is to be an emotional experience, not an intellectual one. The subject must feel (a) how much he or she is loved and (b) how alcohol or drugs is ruining their lives. Presumably, at an intellectual level, the abuser already knows these things, but the value of this knowledge has no effect on their behavior. The interventionist is a paid professional. He or she is paid not for caring for the person admitted but for getting the person admitted. The interventionist takes on the role of Grand Inquisitor and deliverer, rather than that of counselor. But what justifies such a position? Why are there interventionists at all? They’re needed to assist families in convincing a loved one to seek treatment. They are there to offer professional support to those who want their loved one treated. But why do people need an outsider, a stranger, to help convince their loved one to seek treatment? Is it because the interventionist plays the role of the independent facilitator, a disinterested professional? If so, then the position is a fraud. For the interventionist is not independent or disinterested, but is (a) primed to believe the subject is an abuser and (b) paid for delivery of a live customer to the treatment facility. Should the subject agree to enter a treatment facility, he is also entering a world of ideas, the main one being that drug or alcohol abuse is a disease. Many subjects will join a group such as Alcoholics Anonymous, where they will also enter a world of ideas known as the 12-step program. That program, however, sees alcohol abuse as a matter of a weak will. Some may even end up in a facility which tries to treat the disease of alcoholism with the 12-step program of character building, even though these approaches seem contradictory. Diseases cannot be controlled by the will, despite what “alternative” healers like Deepak Chopra and others might claim. Diabetes is not a character flaw. You cannot will your cancer away. Those familiar with A.A. will recognize that the “disease” model of substance abuse contradicts the A.A. model of the weak-willed sinner who needs a “Higher Power” (which can mean anything from the A.A. group itself to the God of the Bible) to conquer the mighty forces of satanic booze. These clashing metaphors of the victim and the sinner are contradictory: the one makes the victim passive and not responsible for being an abuser; the other puts the burden of responsibility on the alcoholic. But it is a meager responsibility, since all the sinner must do to be redeemed is admit he or she is a sinner and turn oneself over to a “Higher Power”. Yet, there are even some A.A. programs which give the nod to the “genetic disease” model of alcoholism. Contradictions apparently do not matter when your goal is noble. The disease model of alcoholism What are the signs of this disease? In addition to craving drink and an inability to stop drinking after one or two drinks, one symptom of this disease is quantity of alcohol consumed. An alcoholic may require rather large amounts of drink before he or she feels a buzz much less feels drunk. If you drink no more than the average American, then you probably do not have this disease. If you drink more than that, then you are probably an alcoholic. The National Institute on Alcohol Abuse and Alcoholism defines a moderate drinker as someone who drinks an average of 3 to 14 drinks a week. A heavy drinker has an average of more than two drinks a day. A drink is 12 ounces of beer, one glass of wine or one shot of liquor. (In case you are wondering, if you drink 3 or more drinks a week you are in the minority: only 27% have that many drinks.) Another symptom of this disease is when you drink. If you drink when stressed or depressed, lonely or bored, to get motivated or amorous, to test yourself or to feel good, then you are very likely an alcoholic. A better sign, however, is suffering from withdrawal symptoms. If you get nauseous, the cold sweats or the shakes when you don't drink, you are without doubt an alcoholic. One of the unique features of this disease is that the effects of the disease are usually first felt by people other than the one suffering from the disease. For most diseases, the sick person feels bad. If the sick person doesn’t feel bad, nobody else feels bad. If alcoholism is a disease, it must be a mental illness. The mentally ill often deny they are ill and the first identification of a mental illness is often when others notice that the afflicted person is behaving in unconventional, bizarre or self-destructive ways. Like other mental illnesses, there is no blood or urine test for alcoholism. There is no physical marker the healer can look for to identify the disease. All the signs are behavioral. Unlike mental illness, however, alcohol abuse is self-inflicted and might better be called brain abuse. One cynical view of the matter is that alcoholism as a disease is not a matter of discovery, but of definition. It is a disease because it has been declared to be so by the very ones who profess to have the cure for the disease. How fortunate for the world that those who define the disease also define the cure! Actually, they don’t have a “cure.” They have a remedy. The inventors of the disease also declare that no one can be cured of this disease. Once an alcoholic, always an alcoholic. You haven’t had a drink in fifty years, you say. That is not evidence that you are no longer an alcoholic. A cure would mean an end to treatment. A remedy means a lifelong income for the SAT provider. The treatment usually begins by being repeatedly told that the first step to recovery is the declaration: I am an alcoholic. For the sinner to be saved, the sinner must first admit he is a sinner. (I am not claiming that A.A. uses the word 'sin' or 'sinner' or 'grace' or that there is any official use of theological terminology.) To refuse to do so is proof the sick one is “in denial” and without grace. The only way to prove you are not in denial is to admit you are an alcoholic. This is only phase one. The next phase is public confession: the subject must declare before others how they have degraded themselves and betrayed their humanity through substance abuse. The point, I suppose, is to get the substance abuser to believe he or she is hopelessly addicted or diabolically possessed (or both) and can be helped only by abandoning oneself to a “Higher Power.” Neither A.A. nor many other SATs are based on science, nor do they seem interested in doing any scientific studies which might test whether the treatment they give is effective. A.A. members know A.A. works, so they don’t need studies to verify the effectiveness of the program. They have very vivid testimonials from people like Bill Wilson, the founder of A.A., of hopeless alcoholics whose only salvation was a religious experience. But others might like to know how many don’t stay and go through the program? How many go through it, but leave? We only hear about the successes, not the failures, because the failures aren’t counted; they aren’t around to be counted. We won’t read about any comparisons with non-A.A. programs, nor will we hear about those substance abusers who quit drinking or drugs without any treatment at all. They didn’t need a “Higher Power” or the group’s help to quit; they did it on their own. How is that possible? If alcoholism is a disease for which there is no cure, and which requires the substance abuser to give oneself over to a “Higher Power,” how do some people quit abusing alcohol or drugs on their own? This should not be possible if either the A.A. philosophy or the disease theory is correct. If alcoholism isn’t a disease, then it is foolish to seek a “cure” for it. It is foolish to have treatment centers with patients who are “suffering from alcoholism.” Even if alcoholism is a sin and a matter of self-control, it is especially foolish to treat all alcoholics with the A.A. 12-step program. All alcoholics don’t come from the same mold. They are not all physically addicted. They are not all psychologically addicted. They are not all addicted. They are not all victims. They are not all diseased. They are not all hopelessly without any self-control. They are not all completely irrational and incompetent. They are not all mentally ill. They don’t all need therapy or medication. There are probably many good programs besides those based on the “disease” or the “sinner” models of the alcoholic. Substance abusers who want to get back some control in their lives might check out some of these other programs and not feel it’s either A.A. or a “chemical dependency” program or nothing. One final note: it seems rather curious that Bill Wilson, founder of A.A., credited people like Carl Jung and William James’s Varieties of Religious Experience for helping him see that “ego collapse” is the common denominator in conversion experiences and that such an experience was the one the alcoholic must have in order to reform. (Wilson also wrote fondly to Jung that some in A.A. had become devotees of psychic powers and the I Ching, a favorite of Jung’s.) Jung had simply thought that some people were hopeless and therapy could do them no good, but perhaps religious devotion could help them. James catalogued experiences as part of his pragmatism: the truth of religion is in its fruits, its effects on a person’s life. The idea is attractive is you keep one eye shut and ignore the Jim Jones, Jerry Falwells, David Koreshes, Peter Popovs, and Pat Robertsons of the world. The idea might seem true to someone whose selective memory ignores all the alcoholic priests, priestesses, and devoted churchgoers. I'll conclude with a formal testimonial given to me by a very good friend who has been sober, thanks to A.A., for more than five years after at least 25 years of abuse of alcohol and a number of legal and illegal substances:
To which I say, Amen brother. See also codependency. further reading
Ofshe, Richard. “The Social Development of the Synanon Cult: The Managerial Strategy of Organizational Transformation,” Sociological Analysis 41: 109-127, 1980. |
 episode 3: 12-step
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©copyright 2006 Robert Todd Carroll |
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updated 03/10/08 |
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